Casualty crisis over doctor shortage

LEADERS of Britain's casualty doctors have warned the Government that an expected shortage of 300 housemen caused by reductions in junior doctors' hours will cripple accident and emergency units in several hospitals next month.

Plans to combat the shortfall mean that nurses will take on extra work and in some units patients with minor injuries may be treated solely by a nurse without seeing a doctor. GPs may also be asked to volunteer to work in casualty units to help out. Patients are being warned they may have to wait longer for treatment.

In a private meeting with Health Minister Gerry Malone last week senior doctors warned of problems looming next month when junior doctors change their six-monthly rota jobs.

The drastic cutback in the hours junior doctors can work is blamed for the growing problem. Disillusionment with medicine as a career among junior doctors, with a 10 per cent fall-out rate, is also a factor.

Consultant Mr Christopher Cutting, President of the British Association of Accident and Emergency Medicine, who was at the meeting, said: "All the indications are that the situation will be very serious. The main factor is the reduction in the hours junior doctors can work without increasing the total numbers of doctors available."

Some areas have managed to recruit fewer than half the doctors they need. At the last count, Mersey region, which has 90 casualty posts for senior house officers, had 58 vacancies. In Wales 22 out of 63 posts were vacant, according to a survey by the British Association of Accident and Emergency Medicine.

"There are not enough doctors to fill the posts," said Mr Cutting. "We estimate that the shortfall will be above 13 per cent but, I hope, not as high as 20 per cent.

Doctors at last week's meeting say a package of proposals to try and deal with the immediate crisis will be announced by the Department of Health.

"The Government are aware of the problem and the object of the meeting was to see what measures in the short term could be helpful to accident and emergency departments," said Mr Cutting. "One idea is having nurses for further duties, perhaps speeding patients through by taking on some extra responsibilities. We already have clinical nurse specialists who see patients, but there may be some way that other nurses can help."

At Taunton and Somerset Hospital, casualty consultant Ian Stewart has been looking at the size of the problem nationally and has so far had 180 replies from hospitals about their problems. He said: "I know there are going to be considerable problems. What is likely to happen is that part-timers will be drafted in, GPs and so on, and patients may have to wait a little longer."

Some doctors want to see more doctors being trained. Although there is to be an increase of around 500, it will take five years for them to qualify. Many doctors believe there should be even more places. A DoH spokesman said: "We did meet the profession about accident and emergency and the issue is being taken seriously."